Posts tagged with 'Industry'

 

Skok-voorbeelde van bedrog by mediese fondse aan die lig gekom

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Die gesondheidsorgbedryf is in die visier van misdaadsindikate en onderduimse praktisyns.

Dr. Gregory Pratt, mediese adviseur vir forensiese ondersoeke in die gesondheidsbedryf vir Medscheme, het op die beraad vir gesondheidsorgfinansiers in Kaapstad skokkende voorbeelde genoem van bedrog waarmee hy die afgelope maande te make gehad het.

Mediese bedrog is so algemeen “omdat dit makliker gepleeg kan word as ander finansiële misdade,” sê hy oor die sindikate wat die bedryf teiken.

Voorbeelde van bedrog die afgelope maande:

1. ’n Sielkundige wat in net 102 dae R4,3 miljoen geëis het, het glo 173 pasiënte op een dag gespreek.

2. ’n Dermatoloog het R112 000 vir net 67 minute in die teater geëis.

3. ’n Sindikaat van sielkundiges in KwaZulu-Natal wat in twee jaar R80 miljoen (sien regstelling) geëis het van een mediese fonds. Baie van dié eise was vals of erg oordrewe.

4. ’n Sindikaat van aptekers in Soweto wat in drie jaar meer as R100
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Vrystaatse gesondheidsdepartement stort in duie na top spesialiste bedank

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Gesondheidsorg in die Vrystaat steier steeds onder die voortdurende eksodus van sy topmedici. Pas het nog twee van die provinsie se voorste spesialiste, prof. Schalk Wentzel (55) by urologie en dr. Maryke Spruit (55) by kritieke sorg, bedank.

Dr. Freek Bester, president van die Suid-Afrikaanse Mediese Vereniging se sentrale tak, sê om die ervaring van die topspesialiste wat die afgelope jaar en ’n half geloop het te probeer ­terugwen, gaan moeilik wees.

“Dit kan tot tien jaar neem om nuwelinge aan te stel en hulle weer op dieselfde gehaltevlak te bring nadat die institusionele geheue verlore gegaan het.

“Die bedankings veroorsaak dat pasiënte wat toenemend nie meer mediese fondse kan bekostig nie aan die lot van onbekwame dokters met swak opleiding en min ervaring blootgestel gaan word.”

Die akademiese platforms by die Universitas- en die Pelonomi-hospitaal, waar mediese studente aan die Universiteit van die Vrystaat opleiding ontvang, se toekoms wor
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Diensjaar: Verpleegster wen hofsaak na regstryd met Gautengse gesondheidsowerheid

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“Dit voel of ’n berg van my skouers af is.”

So het ’n verligte en glimlaggende Dané Hertz (22) Dinsdagmiddag gesê ná haar regstryd met die Gautengse gesondheidsowerheid omdat sy nie uitplasing vir haar verpligte gemeenskapsdiensjaar as verpleegster kon kry nie.

Hertz moet luidens ’n bevel van die hooggeregshof in Pretoria binne 30 dae deur dié owerheid uitgeplaas word na die O.R. Tambo-kliniek, waar sy van die begin af wou werk nadat sy as ’n verpleegkundige gekwalifiseer het. Die kliniek is sowat 8 km van haar huis af.

Die vakbond Solidariteit sê hy het namens Hertz ’n aansoek by dié hof ingedien om haar in ’n gemeenskapsdienspos aangestel te kry omdat die gesondheidsdepartement en minister van gesondheid sedert Januarie “versuim het om haar te plaas”.

Solidariteit het die gesondheidsowerheid op 15 Junie dringend versoek om Hertz, wat einde verlede jaar afgestudeer het, binne sewe dae na ’n kliniek uit te plaas.
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Anger over medicines supply scheme

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It is crucial for the Rev Isaac Harley to take his medication daily – it’s a matter of life and death really.

As a diabetic with a hypertensive comorbidity, he depends on his tablets and insulin to maintain his insulin levels and to manage his high blood pressure.

But it’s been one problem after the next, he told The Sunday Independent, since his medical aid recommended he use its pharmacy’s direct service to deliver his chronic medication to his address instead of claiming from a local pharmacy in his neighbourhood, Elsies River in Cape Town.

“On more than one occasion I’ve had to call to find out what had happened to my medicine.

“During one stint I had no medicines for two weeks because of delivery delays and I didn’t have funds so I had to borrow medication from my mother, who is also diabetic, and money from friends to get the other medication privately,” the 48-year-old said.

In a battle spanning several years, the Independent Community
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Hospital cash-back plans crimped by new law

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The demarcation regulations clearly distinguish between medical insurance products and medical aid schemes. For the consumer, this means that while limited gap cover and hospital cash-back plans will still be allowed, primary healthcare insurance policies will no longer be available. All existing policies will need to align with the regulations from 1 January 2018.

Affected markets

These regulations will primarily affect those between 20 and 35 years of age. The annual Council for Medical Schemes (CMS) report shows that children up to the age of 20 usually stay on their parents’ medical aid. Then you see a significant drop in the number of dependents between the ages of 20 to 35, and then the line goes up again. This is a clear indication that the young and healthy are exercising their freedom of choice to not have medical aid cover. This is the group that, until now, has often relied on hospital cash-back plans for catastrophe cover.
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The most expensive and cheapest medical aids in SA for 2017

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The latest GTC Medical Aid Survey for 2017 has been released, which compares local medical aid schemes on cost to members across various levels of cover.

According to GTC, medical aids are complicated schemes, and comparing them is an almost impossible task; however it has developed a review process that compares schemes across specific categories, rather than on specific services offered.

For its 2017 review, GTC screened 23 medical aids (22 open and 1 closed scheme) offering 144 plans.

The rankings in the GTC Medical Aid Survey are based on the concept of a total cost or a risk rating for each medical aid plan.

This risk rating is derived from a risk premium, which represents the premium paid monthly minus the allocation to what is known as the ‘savings’ or out-of-hospital account.

“This approach removes any differences in personal circumstances, priorities or behaviours that may influence an individual’ eventual healthcare costs,” the group said.

The savi
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Healtcare Services Delivery need to change in Africa

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Healthcare services delivery in Africa needs to change, but no-one is quite certain how. What is certain is that future trends will be driven by access to big data, to shape new models of care in driving innovative, affordable and accessible services, across this diverse continent.

With 1,2bn people, many enjoying a longer life, and the rise of non-communicable diseases (NCDs) there is a growing recognition of the importance of digital innovation in delivering curative and preventive care.

“The transition to digital healthcare offers opportunities to aggregate patient data from multiple sources – for example, from external healthcare providers and specialists who consult to the patient – to give them a single, accurate patient profile.

“This allows healthcare professionals to quickly connect all the dots in a patient’s care, with a view to focusing on optimum outcomes for the patient.In fact, a study in the Journal of Neurology found that putting a digital
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Hier is die 20 beste hospitale in SA

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Die resultate van die nuutste peiling onder pasiënte wat Discovery Health uitgevoer het om die beste hospitale in die land aan te wys, toon sewe hospitale wat al vier jaar agtereenvolgens op die lysie is.

Lede van mediese skemas wat deur Discovery Health geadministreer word, het aan die peiling deelgeneem oor die hospitale waar hulle in 2017 opgeneem is. Die lys is uit 140 hospitale saamgestel.

Life Healthcare, en die onafhanklike netwerk van hospitale wat lede van die National Hospital Network (NHN) is, het die meeste hospitale op die lys.

Netcare het net een hospitaal op die lys.

NHN het die meeste hospitale wat reeds vier jaar agtereenvolgens op die lys is.

Hier is die lys van die 20 beste hospitale in alfabetiese volgorde:

1. Ahmed Al-Kadi- private hospitaal (Durban, KwaZulu-Natal)

2. eThekwini-hospitaal en -hartsentrum (Durban, KwaZulu-Natal)

3. Gateway- private hospitaal (Umhlanga Rocks, KwaZulu-Natal)

4. Hillcrest- private hospitaal (
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Day hospitals: The answer to rising health costs?

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South Africans are faced with the constant increases in the cost of living and an ailing economy, forcing consumers to cut down on spending across the board.

For a small percentage of the population, healthcare costs are covered by medical aid, but only an estimated 16% of South Africans have such coverage while the rest rely on an already overburdened healthcare system. Continuing downward pressure on the economy is pushing even those with medical cover to either reduce it, or outright terminate their membership just to make ends meet, leaving more and more South Africans vulnerable.

While there are several factors contributing to the increase in private healthcare costs, including the volatile exchange rate and its impact on the cost of importing medical equipment, the rising costs of medication, doctors’ fees, the increasing average age of principal members on the schemes, the biggest culprit is private hospital costs.

According to the Council for Medical
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480 narkotiseurs kan SA verlaat oor swak NGV

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Indien narkotiseurs meen dat die Nasionale Gesondheidsversekering (NGV) en die beoogde prysbeheer ’n bedreiging vir hul beroep inhou, kan tot sowat 480 of ’n derde van hulle die land verlaat.

Natalie Zimmelman, uitvoerende hoof van die Suid-Afrikaanse Vereniging van Narkotiseurs (Sasa), het Dinsdag op ’n mediakonferensie die uitslae van ’n peiling onder narkotiseurs oor onder meer die NGV bekend gemaak.

Sy sê narkotiseurs is ’n “hoogs sensitiewe en baie mobiele” arbeidsmag omdat meer as 40% van hulle ook in ander lande geregistreer is. Meer as 50% het reeds in ’n ander land gewerk.

“Hulle kan môre die land verlaat as hulle wil.”

’n Peiling wat verlede jaar vir die markondersoek oor private gesondheidsorg uitgevoer is se inligting is nou vrygestel.

Dit toon 35% of sowat 480 narkotiseurs oorweeg dit om in die komende vyf jaar die land te verlaat. Dit hou met sosio-ekonomiese bedreigings vir hul beroep en hul siening oor die gesondhe
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Medical fraud costs the country’s economy

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The phenomenon of suspiciously qualified or unqualified doctors opening shop in some township and attracting unsuspecting patients has become a concerning norm.

Discussions and debate are focused on state capture and its effect on the economy, but there’s another beast eating away at productivity, hurting the economy and undermining our health system. South Africa is open for medical fraud business.

Medical fraud manifests in two ways: bogus doctors in practice and bogus medical certificates issued to rob employers by keeping an employee away from work while earning a salary.

The phenomenon of suspiciously qualified or unqualified doctors opening practices in some townships and attracting unsuspecting patients has become a concerning norm. Just recently a bogus doctor was caught and arrested at his Mpumalanga surgery in front of patients, some of whom he had prescribed highly regulated schedule 4+ drugs.

These bogus doctors – and even dentists and special
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Allegations of fraud at UKZN medical school – Sama Responds

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The South African Medical Association (Sama) has called on the department of education to act swiftly to deal with allegations of fraud and corruption at the Nelson Mandela School of Medicine, at the University of KwaZulu-Natal (UKZN).

This comes amid allegations that certain members of the community, and some staff members from the UKZN, fraudulently sold students places for admission to the school of medicine. There are also allegations that examination papers are being sold at the university.

“We are extremely concerned about these allegations and call upon the ministry of education to investigate them quickly and effectively. If any staff members are found to be complicit in these activities they must be dealt with decisively. In addition, the leadership of the university must be held accountable, and explain how such a scandalous situation could have occurred in the first place,” said Dr Mzukisi Grootboom, chairperson of Sama.

He said if found to be t
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Climbdown on medical aids

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The Department of Health has done a U-turn on its plan to scrap medical aid schemes, saying they should work with the state when it rolls out National Health Insurance instead.

Department director-general, Precious Matsoso, met leaders of the medical aid plan sector and asked that they work together to reform healthcare in South Africa.

“This is big news,” said Graham Anderson, principal officer of Profmed. The medical aid sector was delighted to be asked to work with the department, because it had been in the dark about NHI for some time, he said.

In the meeting Matsoso made different suggestions on how the government may have to work with the private sector, such as subsidising medical aid options for people who couldn’t afford them.

Finer details of a partnership, however, were not discussed.

Matsoso confirmed the meeting.

She said: “The Department of Health is consulting all stakeholders, private, civil society and labour, to get further inputs [o
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Is your GP contracted in to a medical scheme network?

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If GPs are contracted in to a medical scheme network, they might be pressurised to recommend cheaper treatment options and medications, say SA health bodies.

The Board of Healthcare Funders (BHF) and the IPA Foundation (IPAF) is extremely concerned at the comments made recently by the Health Professions Council of South Africa concerning Designated Service Providers (DSPs).

The HPCSA recently released a statement to the effect that healthcare practitioners should be cautious when concluding designated service provider (DSP) agreements with medical schemes as the medical schemes attempted to reduce costs by applying pressure on practitioners within a DSP network to prescribe medication or recommend treatment options, when other more appropriate, albeit more expensive, options were medically indicated and readily available.

Pushing healthcare costs down

In the current environment where there are no regulated tariffs for healthcare procedures,
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Most affordable medical aid schemes and hospital plans in South-Africa for 2017

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The medical aid industry saw a massive shake-up in April as National Treasury introduced new regulations which will see a limit on the amount of gap cover and hospital cash-back policies you can claim, as well as the discontinuation of all primary healthcare policies.

This is was done in an effort to differentiate between “medical scheme products” and “health insurance”, both of which are regulated by separate Acts causing confusion in the medical arena.

The new regulations will now outlaw all primary healthcare policies from 1 April. According to legislation these are not seen as full medical schemes, instead providing limited medical service benefits, such as GP visits, basic dentistry and optometry, and some acute and chronic medication.

The new laws also stipulate that hospital cash-back plans are limited to paying their clients a maximum of R3,000 per day, or a total lump sum of R20,000 per year. Currently there are no limits in place for these pa
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